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PAIN: Clinical Updates

PAIN: Clinical Updates is a channel of PAIN Reports as well as a section of this open access journal. Each edition is published within the journal, providing timely and accurate information about pain management and therapy on topics of interest to practitioners in various specialties.

According to the current concept, medication overuse headache (MOH) is a secondary headache—a worsening of a pre-existing headache (usually a primary headache) owing to overuse of one or more attack-aborting or painrelieving medications.

Medication overuse headache has a prevalence of around 1% to 2% in the general population and should be suspected in anyone presenting with chronic headache (headache .14 days per month).

Migraine is the underlying headache disorder in most of the cases.

Existing criteria (International Classification of Headache Disorders–3 beta) often make straightforward diagnosis, but controversies around these criteria exist, and other chronic headache disorders may sometimes be difficult to rule out.

Any immediate relief medication has the potential to cause MOH.

Treatment guidelines for MOH are based on expert consensus and include withdrawal strategies, treatment of withdrawal headache, and eventually prophylactic medication for the underlying headache.